Mesh-less laparoscopic treatment of apical prolapse

The pelvic organ prolapse (POP) is a common gynaecological problem, affecting nearly 50% of women over 40. The sacrocolpopexy using a synthetic mesh is now considered the “gold standard” for management of women with apical prolapse. In April 2019 the FDA placed a ban on the production of transvaginal meshes for prolapse due to late complications. The meshes for abdominal repair of POP are still used, but in future they may also be prohibited. The goal of the following video is to present a mesh-less modification of two techniques used for apical organ prolapse, the sacrocolpopexy and the pectopexy.

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Synthetic Mesh Used in Gynecologic Reconstructive Surgery for Pelvic Floor Disorders

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.752.59 ◽

2017 ◽

Vol 752 ◽

pp. 59-63

Author(s):

Elvira Brătilă ◽

Petre Brătilă ◽

Diana Comandașu ◽

Monica Cîrstoiu ◽

Roxana Bohîlțea ◽

...

Keyword(s):

Urinary Incontinence ◽

Pelvic Organ Prolapse ◽

Stress Urinary Incontinence ◽

Pelvic Floor ◽

Pelvic Floor Disorders ◽

Pelvic Organ ◽

Synthetic Mesh ◽

Effective Porosity ◽

Apical Prolapse ◽

Mesh Surgery

Pelvic floor disorders including stress urinary incontinence and pelvic organ prolapse represent a challenge for gynecologist or urogynecologist even nowadays. Conservative treatment for these conditions proves its effectiveness only in few cases selected from early forms of incontinence or prolapse the most cases being solved surgically. The introduction of the procedure imagined by Petros and Ulmsten, known as TVT (Trans Vaginal Tape) in which the medium urethra is supported by a synthetic tape produced in 1996 a revolution in the surgical treatment of stress urinary incontinence. Radical changes also appeared in pelvic organ prolapse surgery extrapolating the hernia repair procedure by using synthetic mesh. After nearly 20 years of experience the mesh surgery is today a common practice in urogynecology. Between 2011 and 2015 we operated in private practice a total number of 297 cases of which 187 cases of stress urinary incontinence and 110 cases of pelvic organ prolapse. From these 86 (78,1%) cases were represented by cystoceles, associated with early apical prolapse or rectoceles, 18 (16,3%) cases by apical prolapse (grade III-IV) and 6 (5,4%) cases by posterior compartment prolapse alone. We performed mesh surgery in 32 (29%) cases represented mainly by anterior compartment prolapse. In 6 (18,7%) cases we founded mesh extrusion which required partially resection. In two cases we performed large resection of anterior vaginal wall required grafting with acellular second generation graft. In all cases with mesh extrusion the biomechanical analysis revealed significant decrease in effective porosity of the mesh due to excessive tensioning or folding of the mesh. The use of mesh in stress urinary incontinence and pelvic organ prolapse represent a justified alternative in selected cases. The specific complications due to meshes are more frequent in prolapse surgery compared to stress urinary incontinence. In all cases altered effective porosity due to technical defects in surgery represents the leading cause.

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Laparoscopic cervicopexy in uterine prolapse, a prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193633 ◽

2019 ◽

Vol 8 (9) ◽

pp. 3492

Author(s):

Anu Aliyar ◽

Saphina Palakkan ◽

Abdul Vahab ◽

Mumtaz P.

Keyword(s):

Pelvic Organ Prolapse ◽

Postoperative Complications ◽

Uterine Prolapse ◽

Pelvic Organ ◽

Synthetic Mesh ◽

Medical College ◽

Younger Age ◽

Effective Option ◽

Mersilene Tape ◽

A Prospective Study

Background: Pelvic organ prolapse is a common condition and a major cause of gynecological surgery. The lifetime risk of having an operation for prolapse may be 11%. Uterine conserving surgeries using synthetic mesh, especially in younger age group can restore normal anatomy relieving their pelvic symptoms. To evaluate the safety, intra operative and postoperative complications and efficacy of the laparoscopic cervicopexy.Methods: This Prospective observational study was carried out on women aged below 45 years attending gynaecology outpatient department with uterine prolapse at MES Medical College, Perinthalmanna between January 1st and December 31st, 2015. 39 women underwent laparoscopic cervicopexy and follow up assessments was done among them at 2 weeks, 3 months and 6 months. Results: The mean operative time was 27.6 minutes and blood loss was 0.4 gm/dl. No intraoperative and postoperative complications occurred. Short duration of hospital stay with mean of 1.4 days. 7.7% patients and 5.5% had mersilene tape reaction at 3 months and 6 months. The POP Q score C was significantly away from hymen at 2 weeks,3 months and 6 months (+4.4 - -4.3). 7.7% and 2.6% had recurrence at 3 month and 6 months. 5.1% underwent vaginal hysterectomy to get relieved from symptom.Conclusion: Laparoscopic cervicopexy is an effective option for women with pelvic organ prolapse who desire uterine preservation.

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FIGO review of statements on use of synthetic mesh for pelvic organ prolapse and stress urinary incontinence

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.12932 ◽

2019 ◽

Vol 147 (2) ◽

pp. 147-155 ◽

Cited By ~ 11

Author(s):

Aiste Ugianskiene ◽

G. Willy Davila ◽

Tsung‐Hsien Su ◽

Keyword(s):

Urinary Incontinence ◽

Pelvic Organ Prolapse ◽

Stress Urinary Incontinence ◽

Pelvic Organ ◽

Synthetic Mesh

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Iatrogenic endometriosis following apical pelvic organ prolapse surgery: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2327-x ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Alkan Cubuk ◽

Orkunt Ozkaptan ◽

Jörg Neymeyer

Keyword(s):

Case Report ◽

Pelvic Organ Prolapse ◽

De Novo ◽

Pelvic Organ ◽

Prolapse Surgery ◽

Uterine Disease ◽

Apical Prolapse ◽

Sacral Promontory ◽

Laparoscopic Supracervical Hysterectomy ◽

Supracervical Hysterectomy

Abstract Background Iatrogenic endometriosis is the presence of endometrial glands and stroma out of the uterus following certain surgical interventions. The rate of iatrogenic endometriosis after gynecologic surgeries due to benign uterine disease is 1–2%. Laparoscopic supracervical hysterectomy is also a part of frequently used surgical treatment of apical pelvic organ prolapse, which is followed by sacrocervicopexy. However, there are no data about iatrogenic endometriosis after apical prolapse surgery in the current literature. Herein, we present a case report of a patient diagnosed with de novo endometriosis 1 year after laparoscopic supracervical hysterectomy and sacrocervicopexy. Case presentation A 46-year-old parous Slavic woman who underwent laparoscopic supracervical hysterectomy and sacrocervicopexy secondary to grade 3 symptomatic apical prolapse 1 year earlier was admitted to the same clinic with pelvic pain that had started 6 months following surgery. Deep vaginal palpation was painful. Transvaginal ultrasonography revealed an area with hypervascularization on the sacral promontory. She was scheduled for diagnostic laparoscopy. A 2 × 2-cm solid, wine-colored, hypervascular hemorrhagic lesion was seen on the sacral promontory. The lesion and the peritoneal layer behind it were totally excised. The patient was discharged on the first postoperative day, without any complications. Pathologic examination revealed foci of endometriosis comprising endometrial glands and stroma within the connective tissue, along with hemosiderin-laden macrophages. The symptoms of the patient resolved after the surgery, and no further adjuvant treatment was needed. Conclusion Although the rate of iatrogenic endometriosis is low after laparoscopic supracervical hysterectomy and sacrocervicopexy, the possibility of the occurrence of iatrogenic endometriosis should be discussed with patients who are diagnosed with apical prolapse to determine the type of surgical intervention. Iatrogenic endometriosis should be kept in mind for differential diagnosis in case of pain after laparoscopic supracervical hysterectomy and sacrocervicopexy.

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Oral Poster 10: Uterine Preservation and the Repair of Apical Prolapse: A Comparison of Transvaginal Surgical Outcomes for Apical Pelvic Organ Prolapse Repair with and without Hysterectomy

Journal of Pelvic Medicine and Surgery ◽

10.1097/01.spv.0000134010.17735.5f ◽

2004 ◽

Vol 10 ◽

pp. S17

Author(s):

R Tyagi ◽

L J. Romanzi

Keyword(s):

Pelvic Organ Prolapse ◽

Surgical Outcomes ◽

Pelvic Organ ◽

Apical Prolapse ◽

Uterine Preservation ◽

Prolapse Repair ◽

Pelvic Organ Prolapse Repair

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Surgical Options for Apical Prolapse Repair

Women s Health ◽

10.2217/whe.12.44 ◽

2012 ◽

Vol 8 (5) ◽

pp. 557-566

Author(s):

Ngoc-Bich Le ◽

Lisa Rogo-Gupta ◽

Shlomo Raz

Keyword(s):

Pelvic Organ Prolapse ◽

Primary Care Physicians ◽

Medical Condition ◽

Pelvic Organ ◽

Medical Community ◽

Apical Prolapse ◽

Prolapse Repair ◽

Common Medical Condition ◽

The Usa ◽

Surgical Options

Pelvic organ prolapse is a common medical condition that affects the quality of life of many women. Approximately 50% of parous women have pelvic organ prolapse and the lifetime risk for surgical intervention is 6.7% at the age of 80 years. In the USA, the number of women at risk for symptomatic prolapse is increasing, which is consistent with the recent increase in the overall number of prolapse and incontinence procedures being performed. Although prolapse is usually multicompartmental and isolated defects are rare, the apical compartment deserves special attention because apical support is integral to a durable prolapse repair. Since many women may initially present to their primary care physicians, all members of the medical community should have a basic understanding of the diagnosis and treatment for apical prolapse.

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